Making a mental health service system more efficient

The County of San Bernardino Department of Behavioral Health (DBH) offers a wide range of mental health, alcohol and substance abuse services for children, transitional age youth, adults and older adults.

San Bernardino boasts the largest area of any county in the contiguous United States and covers 20,052 miles from Los Angeles on the west, to Arizona on the east. A chief goal of the department is to help improve the quality of life for consumers by providing the most appropriate behavioral health services, in the least restrictive manner, at the earliest stage possible. This strategy benefits the consumer, as well as, saves taxpayer dollars.

Keith Harris, Ph.D., Chief of Research and Evaluation, explains why his organization chose SAS to help determine the highest quality, most cost-effective treatments.

The department wanted to work with a vendor that would support the design of a warehouse that would be both enterprise-wide within our own Department, and that would be interoperable with what the broader medical community is using.

Keith Harris, Ph.D
Chief of Research and Evaluation

How does mental health care reduce the cost to taxpayers?

Harris: A significant number of the consumers we serve have serious physical health issues, or needs, that are exacerbated both by mental health challenges and by the complexity of the healthcare service delivery system in the United States. People with multiple stressors are often faced with trying to effectively manage chronic physical conditions like diabetes and heart disease and as a result may end up with urgent needs more frequently. Since DBH is a public agency, most of our consumers do not have private insurance, so their hospital costs are covered by a county program or Medicaid/Medicare. For most consumers, the right care is usually the most cost-effective care. For families and the community, appropriate services can help keep children out of foster care system and in their own homes. These same services can also assist with helping them to be successful and stay in school. Appropriate behavioral health services, available at the right time, also helps foster successful employment so that consumers may learn to live independently without the need of other social service programs.

What are some of the challenges with funding this kind of care?

Harris: As a public agency, part of our funding comes from the state, and those funds are used to match with federal Medicaid funding. Claims to these funding sources require proof of eligibility, so it is important to make sure that the department tracks that information carefully. In addition, federal and state programs want to ensure that the department is using industry best practices and standards of care in the services provided.

Why did you choose SAS?

Harris: The department wanted to work with a vendor that would support the design of a warehouse that would be both enterprise-wide within our own Department, and that would be interoperable with what the broader medical community is using. In addition, SAS supported the department’s need for a comprehensive statistical and analytical software package. SAS provides a comprehensive solution that encompasses training, coordinating, consulting support and a strong product and knowledge base.

How are you using SAS to help manage care?

Harris: The team is building a data warehouse that will integrate data from approximately a dozen different systems, many of which do not talk directly with one another at this time. We will be mining the data and building a dashboard where deputy directors can see information in as real-time as the data allows – for example, how many consumers are awaiting services and how many are in need of hospitalization. The dashboard will track all the different types of services – from counseling and therapy to medication – as well as report on outcomes for administrative staff to use in decision-making.

How is that different than what you were doing?

Harris: The department currently has a transactional-based system, however there are limitations to what these systems can do. For much of the important information, e.g. if something about the consumer's care changed, the history of the data would be lost. For one to watch change over time to refine the service-delivery approach for a consumer as needed, the history for that particular consumer would be very important to consider. With the transactional-based system there is no way to obtain feedback on what is working. Clinical and support staff typically provide services based on experience, from what they read in journals and/or from what they learn from peers. With this improved system staff will have a data-driven decision support system, not to replace professional judgment but to supplement and complement it. This improved system will allow the department to use system indicators and performance outcome measures to identify what works.

Is this different than clinical trials?

Harris: Yes. This is about tracking what we are doing in the real world and seeing how it works. With an electronic health record and a data warehouse, the department will eventually be able to end our reliance on paper-based charts – and that is important because we are a large county and consumers, many times, end up seeking treatment at different clinic sites. In addition, if one consumer ends up in a hospital for a physical health problem, that data would become available to authorized staff. In the larger picture, providers can begin to see patterns on what treatments are helping consumers function most effectively. Again, this is a decision support system, not a substitute for large clinical trials.

Challenge

Treat behavioral health issues in an effective and cost-efficient manner.

Solution

Benefits

A holistic and integrated view of consumers that allows the county to analyze needs, design effective programs and predict – and plan for – future needs.

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